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Article in Japanese

Clinical features of pediatric empyema at a children’s hospital

Ayumi TADA1) , Kimihiro TANIGUCHI1) , Keiko SONEDA1) , Hanako FUNAKOSHI1) , Yuho HORIKOSHI1)

Pediatric empyema is a rare complication of pneumonia, which can be severe and difficult to treat. In this study, we retrospectively reviewed 14 cases of empyema diagnosed at our hospital between March 2010 and December 2021. Patients had a median age of 8.5 (IQR: 3.2-12) years, and five (36%) of them had comorbidities. The causative bacteria were identified in nine cases (64%) by pleural fluid culture in eight cases and rapid antigen test by latex agglutination reaction in one case, and Streptococcus pneumoniae, Staphylococcus aureus, group A Streptococcus, and Streptococcus anginosus group were identified in 2 cases each, respectively. Pleural fluid cultures were still positive for four of eight patients (50%) with prior antimicrobial therapy. All patients received intravenous antibiotics. Chest tube drainage or thoracentesis was performed in 13 cases (93%), intrapleural fibrinolytic therapy was performed in eight cases (57%), and videoassisted thoracoscopic surgery was conducted in four cases (29%). The median time from diagnosis to surgery was 7.5 (IQR: 6.5-8.2) days. Two patients (14%) required mechanical ventilation. None of our patients had recurrent empyema or developed chronic empyema. In pediatric empyema, latex agglutination tests may be useful to identify a pathogen, as bacterial culture may not reveal a pathogen in many cases. In this study, the long-term prognosis was favorable, but the choice of treatment method and timing require further study.

1)Division of Infectious Disease, Department of Pediatrics, Tokyo Metropolitan Children’s Medical Center

Key words empyema, latex agglutination reaction, intrapleural fibrinolytic therapy, VATS
Received February 15, 2022
Accepted November 29, 2022

34 (4):263─270,2022